Provider Demographics
NPI:1396953121
Name:CHONKO, KIMBERLY E
Entity type:Individual
Prefix:PROF
First Name:KIMBERLY
Middle Name:E
Last Name:CHONKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1285
Mailing Address - Country:US
Mailing Address - Phone:207-844-8287
Mailing Address - Fax:
Practice Address - Street 1:41 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1285
Practice Address - Country:US
Practice Address - Phone:207-844-8287
Practice Address - Fax:207-844-8245
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1416174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist